Estimated disability-adjusted life years averted by long-term provision of long acting contraceptive methods in a Brazilian clinic

Bahamondes, Luís; Bottura, Bruna F.; Bahamondes, M. Valeria; Gonçalves, Mayara P.; Correia, Vinicius Machado; Espejo-Arce, Ximena; Sousa, Maria Helena de; Monteiro, Ilza; Fernandes, Arlete

doi:10.1093/humrep/deu191

Cited by 35 publications

(43 citation statements)

References 30 publications

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“…Conversely, the sales of LARC methods, the most effective contraceptive methods, have been very low, [18][19][20] even during the recent Zika virus outbreak. 21 This reflects the fact that most women are using contraceptive methods such as COCs, progestin-only pills, injectable and emergency contraceptives, all of which are much less effective than LARC methods.…”

Section: 18mentioning

confidence: 99%

Untitled

2017

Rev Bras Ginecol Obstet

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Rev Bras Ginecol Obstet 2017;39:373-375.Around 50-55% of all births in Brazil are unplanned, and these figures include both unwanted and mistimed pregnancies. 1,2 The overall rate of induced abortion is estimated at 1.5%, with all induced abortions resulting from unplanned pregnancies culminating in an adjusted abortion rate of 2.7%. In many cases, unplanned pregnancies terminate in induced abortions and, since abortion in Brazil is restricted and only allowed under certain circumstances, many of these procedures are unsafe. Indeed, unsafe abortions are estimated to account for 13% of all maternal deaths. 3,4 The cost of unplanned pregnancies weighs not only on the healthcare system but also on society, and involves the cost of abortion care and of unplanned childbirth. When the pregnancy is unplanned, the likelihood of preterm births and low birthweight infants increases, and this scenario implies high costs associated with neonatal care and longterm disabilities. 5,6 The total fertility rate in Brazil has fallen significantly in recent decades, and today stands at 1.8 births per woman. Over the same period, the use of contraceptives has increased. 7,8 Preventing unplanned pregnancies through publicly funded programs is a strategy that has proven to be effective in significantly cutting costs for health services. 9 In this editorial, we will discuss the current situation in Brazil, providing an insight into the inequalities that exist in the provision of contraceptive methods, particularly long-acting reversible contraceptive (LARC) methods, and highlighting the causes and consequences of unplanned pregnancies in Brazil, where fertility planning services are vastly different to those provided in developed countries, and where abortion legislation is restrictive.The Brazilian National Healthcare Service (SUS, in the Portuguese acronym) covers the cost of around 70-75% of all procedures performed in the country, including those related to reproduction. An estimated 1.79 million unplanned pregnancies and 1.47 million planned pregnancies occur annually, with 351 maternal deaths, of which 49 (14%) are attributed to abortions, and 302 to complications resulting from miscarriages and childbirth. The number of infant deaths in the first year of life is estimated at 32,864. The model estimates the number of preterm deliveries attributed to unplanned pregnancies at 122,523. The estimated number of neonatal admissions associated with unplanned pregnancies was 224,631 for 2010, including all preterm deliveries and 7.6% of all term deliveries. 10 Consequently, the total annual costs attributed to unplanned pregnancies are estimated at R$4.1 billion or more, depending on the exchange rate. Approximately R$4.07 billion (99.2%) of that total amount is attributed to childbirth and its resulting complications. Based on national cost estimates and the number of unplanned pregnancies per year, the cost per unplanned pregnancy is calculated at R $4,439. However, this is based only on cases occurring within the public healthcare sys...

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Section: 18mentioning

confidence: 99%

Untitled

2017

Rev Bras Ginecol Obstet

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“…One example was our evaluation of the last 10 years’ experience at a Brazilian family planning clinic based in Campinas. Our group estimated the contribution of the provision of LARC methods and the depot-medroxyprogesterone acetate injectable contraceptive to averted disability-adjusted life years (DALY; maternal mortality and morbidity, child mortality and abortions) and provided evidence about these indicators 2. The objective of the present study was to estimate the averted DALY11 among LNG-IUS users who received the device at no cost at 26 Brazilian teaching hospitals from 2007 to 2015.…”

Section: Introductionmentioning

confidence: 99%

Estimated disability-adjusted life years averted by free-of-charge provision of the levonorgestrel-releasing intrauterine system over a 9-year period in Brazil

Ferreira

Monteiro

Fernandes

et al. 2017

J Fam Plann Reprod Health Care

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Provision of the LNG-IUS at no cost to low-income Brazilian women reduced unwanted pregnancies and probably averted maternal mortality and morbidity, child mortality and unsafe abortions. Family planning programs, policymakers and stakeholders based in low-resource settings could take advantage of the information that the provision of this contraceptive at no cost, or at affordable cost to a publicly-insured population, is an effective policy to help promote women's health.

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“…The levonorgestrel-releasing intrauterine system (LNG-IUS) is one of the most effective reversible contraceptives with a pregnancy failure rate between 0.01-0.3 per 100 womanyears [1,2] and also presents additional non-contraceptive benefits, such as control of heavy menstrual bleeding. [3] Furthermore, many researchers have reported that almost 90% of users were satisfied with this method at the end of the first year after placement.…”

Section: Introductionmentioning

confidence: 99%